Full Transcript Introduction to progesterone sensitivity 0:01 protect that uterine lining and 0:01 protect that uterine lining and cuz if you're having a thickening of the 0:03 cuz if you're having a thickening of the 0:03 cuz if you're having a thickening of the uterine lining cuz of that estrogen and 0:04 uterine lining cuz of that estrogen and 0:04 uterine lining cuz of that estrogen and you don't have enough progesterone that 0:06 you don't have enough progesterone that 0:06 you don't have enough progesterone that can put you at risk for uterine cancer.
What oral progesterone intolerance feels like 0:13 Oral progesterone sensitivity and what 0:13 Oral progesterone sensitivity and what you can do about it. Hi, I'm Dr. Valerie 0:15 you can do about it. Hi, I'm Dr. Valerie 0:15 you can do about it. Hi, I'm Dr. Valerie Davidson from the Progressive Health 0:16 Davidson from the Progressive Health 0:16 Davidson from the Progressive Health podcast. 0:17 podcast. 0:17 podcast. >> I'm Dr. Mackey from the Progressive 0:18 >> I'm Dr. Mackey from the Progressive 0:18 >> I'm Dr. Mackey from the Progressive Health podcast. Uh so this is one that 0:21 Health podcast. Uh so this is one that 0:21 Health podcast. Uh so this is one that comes up all the time. Um you know, 0:23 comes up all the time. Um you know, 0:23 comes up all the time. Um you know, tolerance to progesterone. So what is 0:26 tolerance to progesterone. So what is 0:26 tolerance to progesterone. So what is your experience been over the last 25 0:28 your experience been over the last 25 0:29 your experience been over the last 25 years? 0:29 years? 0:29 years? >> Um definitely the oral progesterone.
Common side effects and dose issues 0:32 >> Um definitely the oral progesterone. 0:32 >> Um definitely the oral progesterone. Some women love it. They say I sleep 0:34 Some women love it. They say I sleep 0:34 Some women love it. They say I sleep like a baby. My mood is awesome. And 0:36 like a baby. My mood is awesome. And 0:36 like a baby. My mood is awesome. And then there's other women 0:38 then there's other women 0:38 then there's other women don't love it. So that's where you want 0:40 don't love it. So that's where you want 0:40 don't love it. So that's where you want to find some alternatives to women that 0:41 to find some alternatives to women that 0:42 to find some alternatives to women that can't take the oral progesterone. Cuz I 0:43 can't take the oral progesterone. Cuz I 0:43 can't take the oral progesterone. Cuz I do feel really bad for a lot of women 0:45 do feel really bad for a lot of women 0:45 do feel really bad for a lot of women that have written in or they've come in 0:47 that have written in or they've come in 0:47 that have written in or they've come in to see us as new patients and they're 0:48 to see us as new patients and they're 0:48 to see us as new patients and they're like their doctor won't do anything 0:50 like their doctor won't do anything 0:50 like their doctor won't do anything different, but they feel terrible on it.
Why oral progesterone can cause symptoms 0:52 different, but they feel terrible on it. 0:52 different, but they feel terrible on it. Then they try not to take it, which 0:53 Then they try not to take it, which 0:53 Then they try not to take it, which probably isn't a good idea if you have a 0:55 probably isn't a good idea if you have a 0:55 probably isn't a good idea if you have a uterus and you're taking estradiol. So 0:57 uterus and you're taking estradiol. So 0:57 uterus and you're taking estradiol. So they always feel like they're kind of 0:58 they always feel like they're kind of 0:58 they always feel like they're kind of stuck, you know, like stuck in a corner. 1:00 stuck, you know, like stuck in a corner. 1:00 stuck, you know, like stuck in a corner. But maybe we'll go over a little bit of 1:02 But maybe we'll go over a little bit of 1:02 But maybe we'll go over a little bit of the symptoms that you can have from 1:04 the symptoms that you can have from 1:04 the symptoms that you can have from having a progesterone or oral 1:06 having a progesterone or oral 1:06 having a progesterone or oral progesterone sensitivity. 1:07 progesterone sensitivity. 1:07 progesterone sensitivity. >> Now again, this is a man telling women 1:09 >> Now again, this is a man telling women 1:09 >> Now again, this is a man telling women how they're going to feel on their 1:10 how they're going to feel on their 1:10 how they're going to feel on their female hormones. So take that with a 1:12 female hormones. So take that with a 1:12 female hormones. So take that with a grain of salt, but we've been doing this 1:13 grain of salt, but we've been doing this 1:13 grain of salt, but we've been doing this a long time. 1:15 a long time. 1:15 a long time. If you don't tolerate oral progesterone, 1:17 If you don't tolerate oral progesterone, 1:17 If you don't tolerate oral progesterone, you're going to you're going to note it 1:18 you're going to you're going to note it 1:18 you're going to you're going to note it right you notice it right away. I mean, 1:20 right you notice it right away. I mean, 1:20 right you notice it right away. I mean, it's not something that you have to like 1:21 it's not something that you have to like 1:21 it's not something that you have to like wait, you know, and find out, you know, 1:24 wait, you know, and find out, you know, 1:24 wait, you know, and find out, you know, relatively quickly if you're one of 1:25 relatively quickly if you're one of 1:25 relatively quickly if you're one of those women that don't tolerate. It's 1:27 those women that don't tolerate. It's 1:27 those women that don't tolerate. It's going to show up relative relatively 1:29 going to show up relative relatively 1:29 going to show up relative relatively quick, but it does depend on the 1:31 quick, but it does depend on the 1:31 quick, but it does depend on the starting doses. 1:32 starting doses. 1:32 starting doses. >> Let's talk about what they would feel. 1:35 >> Let's talk about what they would feel. 1:35 >> Let's talk about what they would feel. >> Sure. 1:36 >> Sure. 1:36 >> Sure. Go ahead. 1:38 Go ahead. 1:38 Go ahead. >> No, I'm just kidding. No, [laughter] one 1:40 >> No, I'm just kidding. No, [laughter] one 1:40 >> No, I'm just kidding. No, [laughter] one of the biggest things I would say is and 1:42 of the biggest things I would say is and 1:42 of the biggest things I would say is and and those of you probably know too is 1:43 and those of you probably know too is 1:43 and those of you probably know too is feeling tired and groggy. 1:45 feeling tired and groggy. 1:45 feeling tired and groggy. >> Yeah, yeah. 1:45 >> Yeah, yeah. 1:45 >> Yeah, yeah. >> That's the big one. Some women say they 1:46 >> That's the big one. Some women say they 1:46 >> That's the big one. Some women say they feel like they're drugged.
Alternatives to oral progesterone 1:48 feel like they're drugged. 1:48 feel like they're drugged. >> Sure, yeah. They take it the night 1:49 >> Sure, yeah. They take it the night 1:49 >> Sure, yeah. They take it the night before to help them sleep. They wake up 1:51 before to help them sleep. They wake up 1:51 before to help them sleep. They wake up in the morning and they're just like a 1:53 in the morning and they're just like a 1:53 in the morning and they're just like a little bit of a zombie trying to get the 1:54 little bit of a zombie trying to get the 1:54 little bit of a zombie trying to get the day started. 1:56 day started. 1:56 day started. You know, now what we have seen a few 1:58 You know, now what we have seen a few 1:58 You know, now what we have seen a few times though, some doctors or 1:59 times though, some doctors or 1:59 times though, some doctors or practitioners will start women out right 2:01 practitioners will start women out right 2:01 practitioners will start women out right out of the gate at 200 mg. We don't 2:04 out of the gate at 200 mg. We don't 2:04 out of the gate at 200 mg. We don't usually start out at 200 mg. We always 2:07 usually start out at 200 mg. We always 2:07 usually start out at 200 mg. We always start out at 100 and then work our way 2:09 start out at 100 and then work our way 2:09 start out at 100 and then work our way up from there. Maybe it's 125, maybe 2:11 up from there. Maybe it's 125, maybe 2:11 up from there. Maybe it's 125, maybe it's 150, maybe 175, you know, 200. Um 2:15 it's 150, maybe 175, you know, 200. Um 2:15 it's 150, maybe 175, you know, 200. Um we don't usually have to go beyond 200, 2:18 we don't usually have to go beyond 200, 2:18 we don't usually have to go beyond 200, but starting right off the bat at 200 2:19 but starting right off the bat at 200 2:20 but starting right off the bat at 200 can be a pretty hefty dosage. 2:21 can be a pretty hefty dosage. 2:21 can be a pretty hefty dosage. >> Yeah, so dose-dependent could create 2:23 >> Yeah, so dose-dependent could create 2:23 >> Yeah, so dose-dependent could create some of the symptoms like that 2:24 some of the symptoms like that 2:24 some of the symptoms like that grogginess, feeling drugged. Women will 2:26 grogginess, feeling drugged. Women will 2:26 grogginess, feeling drugged. Women will say they're so tired in the morning that 2:28 say they're so tired in the morning that 2:28 say they're so tired in the morning that they can't get to the gym. They'll also 2:30 they can't get to the gym. They'll also 2:30 they can't get to the gym. They'll also increase appetite can happen from the 2:32 increase appetite can happen from the 2:32 increase appetite can happen from the oral progesterone. You can and anxiety.
Protecting the uterine lining on estrogen 2:35 oral progesterone. You can and anxiety. 2:35 oral progesterone. You can and anxiety. You'd be surprised at how women how many 2:37 You'd be surprised at how women how many 2:37 You'd be surprised at how women how many women get anxiety from taking oral 2:39 women get anxiety from taking oral 2:39 women get anxiety from taking oral progesterone, which anxiety is the worst 2:41 progesterone, which anxiety is the worst 2:41 progesterone, which anxiety is the worst feeling in the world. So and bloating, 2:43 feeling in the world. So and bloating, 2:43 feeling in the world. So and bloating, I've seen a lot in my clinical 2:44 I've seen a lot in my clinical 2:44 I've seen a lot in my clinical experience. They start that progesterone 2:45 experience. They start that progesterone 2:45 experience. They start that progesterone and they immediately bloat. So of course 2:48 and they immediately bloat. So of course 2:48 and they immediately bloat. So of course it could definitely be a dosing issue. 2:50 it could definitely be a dosing issue. 2:50 it could definitely be a dosing issue. >> Yeah. 2:50 >> Yeah. 2:50 >> Yeah. >> So a dosing issue, but then I think 2:53 >> So a dosing issue, but then I think 2:53 >> So a dosing issue, but then I think partly too is when you take an oral 2:54 partly too is when you take an oral 2:54 partly too is when you take an oral progesterone, it has to go through that 2:56 progesterone, it has to go through that 2:56 progesterone, it has to go through that first pass in the liver that it'll 2:58 first pass in the liver that it'll 2:58 first pass in the liver that it'll create that allopregnanolone, you know, 3:00 create that allopregnanolone, you know, 3:00 create that allopregnanolone, you know, all this fun science stuff, but 3:02 all this fun science stuff, but 3:02 all this fun science stuff, but ultimately that can modulate GABA, which 3:05 ultimately that can modulate GABA, which 3:05 ultimately that can modulate GABA, which is supposed to help you sleep better and 3:06 is supposed to help you sleep better and 3:06 is supposed to help you sleep better and feel, you know, calm and relaxed and my 3:09 feel, you know, calm and relaxed and my 3:09 feel, you know, calm and relaxed and my mood is good, but other women some women 3:11 mood is good, but other women some women 3:11 mood is good, but other women some women are really sensitive to that GABA 3:13 are really sensitive to that GABA 3:13 are really sensitive to that GABA response and they'll get anxiety. 3:15 response and they'll get anxiety. 3:15 response and they'll get anxiety. They'll get, you know, a lot of anxiety 3:17 They'll get, you know, a lot of anxiety 3:17 They'll get, you know, a lot of anxiety or they'll feel so tired the next 3:19 or they'll feel so tired the next 3:19 or they'll feel so tired the next morning from that allopregnanolone, um 3:21 morning from that allopregnanolone, um 3:21 morning from that allopregnanolone, um you know, the metabolites from the 3:22 you know, the metabolites from the 3:22 you know, the metabolites from the progesterone going through the liver. 3:24 progesterone going through the liver. 3:24 progesterone going through the liver. I find that two um progesterone itself
Monitoring bleeding and uterine safety 3:27 I find that two um progesterone itself 3:27 I find that two um progesterone itself through a whole big process and valley 3:31 through a whole big process and valley 3:31 through a whole big process and valley can, you know, through 3:31 can, you know, through 3:32 can, you know, through 17-hydroxyprogesterone 3:33 17-hydroxyprogesterone 3:33 17-hydroxyprogesterone in a few different ways, it can turn 3:35 in a few different ways, it can turn 3:35 in a few different ways, it can turn into cortisol. It's not supposed to go 3:36 into cortisol. It's not supposed to go 3:37 into cortisol. It's not supposed to go that way. That's not the natural 3:38 that way. That's not the natural 3:38 that way. That's not the natural direction that the body wants to promote 3:40 direction that the body wants to promote 3:40 direction that the body wants to promote progesterone to go through, but I think 3:42 progesterone to go through, but I think 3:42 progesterone to go through, but I think that might be one of the issues that 3:44 that might be one of the issues that 3:44 that might be one of the issues that I've run across with women that get that 3:45 I've run across with women that get that 3:46 I've run across with women that get that terrible anxiety with oral progesterone. 3:48 terrible anxiety with oral progesterone. 3:48 terrible anxiety with oral progesterone. >> Yeah. Uh and that, you know, I think 3:49 >> Yeah. Uh and that, you know, I think 3:49 >> Yeah. Uh and that, you know, I think we've He's using oral progesterone for a 3:52 we've He's using oral progesterone for a 3:52 we've He's using oral progesterone for a very long time. If there's one tool that 3:55 very long time. If there's one tool that 3:55 very long time. If there's one tool that you're going to at least try, it's going 3:57 you're going to at least try, it's going 3:57 you're going to at least try, it's going to be oral progesterone. Okay, it's not 4:00 to be oral progesterone. Okay, it's not 4:00 to be oral progesterone. Okay, it's not as we're talking about it, it's not 4:02 as we're talking about it, it's not 4:02 as we're talking about it, it's not 100% effective in everyone. There is a 4:04 100% effective in everyone. There is a 4:04 100% effective in everyone. There is a little bit of intolerance, and that 4:06 little bit of intolerance, and that 4:06 little bit of intolerance, and that seems like the more women that are using 4:08 seems like the more women that are using 4:08 seems like the more women that are using HRT these days, now that population of 4:11 HRT these days, now that population of 4:11 HRT these days, now that population of women that don't tolerate well has sort 4:13 women that don't tolerate well has sort 4:13 women that don't tolerate well has sort of gone up a little bit. You know, so 4:15 of gone up a little bit. You know, so 4:15 of gone up a little bit. You know, so now it's it's sort of a theme that you 4:17 now it's it's sort of a theme that you 4:17 now it's it's sort of a theme that you see on social media and on YouTube. 4:20 see on social media and on YouTube. 4:20 see on social media and on YouTube. Now, let's should we transition to 4:23 Now, let's should we transition to 4:24 Now, let's should we transition to what other options there are if they 4:26 what other options there are if they 4:26 what other options there are if they don't if they don't tolerate oral
Rhythmic dosing and cyclic progesterone use 4:28 don't if they don't tolerate oral 4:28 don't if they don't tolerate oral progesterone? 4:29 progesterone? 4:29 progesterone? >> you said, the dosing is an issue, so 4:31 >> you said, the dosing is an issue, so 4:31 >> you said, the dosing is an issue, so maybe the dose was too high out of the 4:32 maybe the dose was too high out of the 4:32 maybe the dose was too high out of the gate. There is also the option of 4:34 gate. There is also the option of 4:35 gate. There is also the option of vaginal capsules. So, the suppositories 4:38 vaginal capsules. So, the suppositories 4:38 vaginal capsules. So, the suppositories progesterone suppositories can be a 4:39 progesterone suppositories can be a 4:39 progesterone suppositories can be a little messy and a little um 4:42 little messy and a little um 4:42 little messy and a little um you know, you have to wear panty liner. 4:43 you know, you have to wear panty liner. 4:43 you know, you have to wear panty liner. Even with the vaginal capsules, you have 4:44 Even with the vaginal capsules, you have 4:44 Even with the vaginal capsules, you have to as well. But using vaginally using 4:47 to as well. But using vaginally using 4:47 to as well. But using vaginally using vaginal capsules of progesterone you 4:50 vaginal capsules of progesterone you 4:50 vaginal capsules of progesterone you know, inserting it vaginally in the 4:51 know, inserting it vaginally in the 4:51 know, inserting it vaginally in the vaginal vault at night can be a great 4:53 vaginal vault at night can be a great 4:53 vaginal vault at night can be a great way to bypass that liver and causing 4:56 way to bypass that liver and causing 4:56 way to bypass that liver and causing those metabolites that are going to make 4:57 those metabolites that are going to make 4:58 those metabolites that are going to make you tired. And it can also, like I said, 5:00 you tired. And it can also, like I said, 5:00 you tired. And it can also, like I said, sometimes that progesterone oral can 5:02 sometimes that progesterone oral can 5:02 sometimes that progesterone oral can affect the hypothalamus and increase up 5:04 affect the hypothalamus and increase up 5:04 affect the hypothalamus and increase up the appetite. So, by doing it vaginally, 5:06 the appetite. So, by doing it vaginally, 5:06 the appetite. So, by doing it vaginally, you can bypass that. But I have had some 5:08 you can bypass that. But I have had some 5:08 you can bypass that. But I have had some women when we're you know, using vaginal 5:10 women when we're you know, using vaginal 5:10 women when we're you know, using vaginal capsules of progesterone still feel 5:12 capsules of progesterone still feel 5:12 capsules of progesterone still feel tired the next morning. 5:14 tired the next morning. 5:14 tired the next morning. >> Yeah. So, it's just really kind of 5:15 >> Yeah. So, it's just really kind of 5:15 >> Yeah. So, it's just really kind of finding out what fits for you in terms 5:17 finding out what fits for you in terms 5:17 finding out what fits for you in terms of that. 5:17 of that. 5:17 of that. >> Now, let's put that in context with 5:21 >> Now, let's put that in context with 5:21 >> Now, let's put that in context with using some estrogen, some form of 5:23 using some estrogen, some form of 5:23 using some estrogen, some form of estrogen. So, let's say a woman is on, 5:25 estrogen. So, let's say a woman is on, 5:25 estrogen. So, let's say a woman is on, you know, bioest, the patch, it doesn't 5:27 you know, bioest, the patch, it doesn't 5:27 you know, bioest, the patch, it doesn't really matter. And now she does not 5:29 really matter. And now she does not 5:29 really matter. And now she does not tolerate oral progesterone. Can she just
Tailoring treatment and other delivery methods 5:33 tolerate oral progesterone. Can she just 5:33 tolerate oral progesterone. Can she just go to a cream? 5:34 go to a cream? 5:34 go to a cream? >> Well, that's the thing is if you have a 5:36 >> Well, that's the thing is if you have a 5:36 >> Well, that's the thing is if you have a uterus, you want to protect that uterine 5:38 uterus, you want to protect that uterine 5:38 uterus, you want to protect that uterine lining 5:39 lining 5:39 lining cuz if you're having a thickening of the 5:40 cuz if you're having a thickening of the 5:40 cuz if you're having a thickening of the uterine lining cuz of that estrogen and 5:42 uterine lining cuz of that estrogen and 5:42 uterine lining cuz of that estrogen and you don't have enough progesterone, that 5:43 you don't have enough progesterone, that 5:43 you don't have enough progesterone, that can put you at risk for uterine cancer. 5:45 can put you at risk for uterine cancer. 5:45 can put you at risk for uterine cancer. So, that's where we know the studies 5:48 So, that's where we know the studies 5:48 So, that's where we know the studies have so many more studies on oral 5:49 have so many more studies on oral 5:49 have so many more studies on oral progesterone and protecting the uterine 5:51 progesterone and protecting the uterine 5:51 progesterone and protecting the uterine lining with using estradiol as HRT 5:54 lining with using estradiol as HRT 5:54 lining with using estradiol as HRT because it's been around for so long. 5:56 because it's been around for so long. 5:56 because it's been around for so long. There's not as many studies on 5:57 There's not as many studies on 5:57 There's not as many studies on progesterone cream, probably because 6:00 progesterone cream, probably because 6:00 progesterone cream, probably because it's, you know, maybe there's, you know, 6:02 it's, you know, maybe there's, you know, 6:02 it's, you know, maybe there's, you know, hasn't been around as long or it hasn't 6:03 hasn't been around as long or it hasn't 6:03 hasn't been around as long or it hasn't been utilized as often. I feel like in 6:06 been utilized as often. I feel like in 6:06 been utilized as often. I feel like in some women using the progesterone cream, 6:08 some women using the progesterone cream, 6:08 some women using the progesterone cream, now this is not for medical advice, this 6:10 now this is not for medical advice, this 6:10 now this is not for medical advice, this is for education only, we always have to 6:12 is for education only, we always have to 6:12 is for education only, we always have to say that, but some women can tolerate 6:15 say that, but some women can tolerate 6:15 say that, but some women can tolerate progesterone cream, 6:16 progesterone cream, 6:16 progesterone cream, you know, even using it vaginally if 6:18 you know, even using it vaginally if 6:18 you know, even using it vaginally if they're doing estradiol as part of their 6:20 they're doing estradiol as part of their 6:20 they're doing estradiol as part of their HRT regime. And then there's some women 6:22 HRT regime. And then there's some women 6:22 HRT regime. And then there's some women that just can't. They just start 6:24 that just can't. They just start 6:24 that just can't. They just start bleeding. 6:24 bleeding. 6:24 bleeding. >> Yeah. Uh and that's really the the 6:26 >> Yeah. Uh and that's really the the 6:26 >> Yeah. Uh and that's really the the distinction there. You could use it in 6:28 distinction there. You could use it in 6:28 distinction there. You could use it in theory and potentially, but it just 6:30 theory and potentially, but it just 6:30 theory and potentially, but it just depends if your uterus is going to allow 6:32 depends if your uterus is going to allow 6:32 depends if your uterus is going to allow you to use it or not. And there's no way 6:34 you to use it or not. And there's no way 6:34 you to use it or not. And there's no way to know ahead of time, oh I took oral 6:36 to know ahead of time, oh I took oral 6:36 to know ahead of time, oh I took oral progesterone, it didn't do I didn't feel 6:38 progesterone, it didn't do I didn't feel 6:38 progesterone, it didn't do I didn't feel well, I'm going to switch to a cream, 6:40 well, I'm going to switch to a cream, 6:40 well, I'm going to switch to a cream, it's not that easy. Uh you know, so you 6:43 it's not that easy. Uh you know, so you 6:43 it's not that easy. Uh you know, so you have to do that uh and then and kind of 6:46 have to do that uh and then and kind of 6:46 have to do that uh and then and kind of keep your fingers crossed that it 6:47 keep your fingers crossed that it 6:47 keep your fingers crossed that it doesn't cause any bleeding. Now, you 6:50 doesn't cause any bleeding. Now, you 6:50 doesn't cause any bleeding. Now, you mentioned uterine cancer. You're not 6:51 mentioned uterine cancer. You're not 6:51 mentioned uterine cancer. You're not going to get uterine cancer in a week. 6:53 going to get uterine cancer in a week. 6:53 going to get uterine cancer in a week. >> Yeah, no. 6:53 >> Yeah, no. 6:53 >> Yeah, no. >> No, you're not going to get it in a 6:54 >> No, you're not going to get it in a 6:54 >> No, you're not going to get it in a month, you're not going to get it, but 6:56 month, you're not going to get it, but 6:56 month, you're not going to get it, but the job of the practitioner is to keep 6:58 the job of the practitioner is to keep 6:58 the job of the practitioner is to keep the patient safe. So, we have to figure 7:01 the patient safe. So, we have to figure 7:01 the patient safe. So, we have to figure that out relatively quickly. Um so that 7:04 that out relatively quickly. Um so that 7:04 that out relatively quickly. Um so that way uh you know, um now in some ways
When progesterone is not tolerated 7:07 way uh you know, um now in some ways 7:07 way uh you know, um now in some ways bleeding right off the bat is sort of a 7:08 bleeding right off the bat is sort of a 7:08 bleeding right off the bat is sort of a good thing because it 7:10 good thing because it 7:10 good thing because it >> I don't think so. 7:10 >> I don't think so. 7:10 >> I don't think so. >> Well, not a good thing, but it's a 7:12 >> Well, not a good thing, but it's a 7:12 >> Well, not a good thing, but it's a warning sign that hey, this isn't 7:13 warning sign that hey, this isn't 7:13 warning sign that hey, this isn't working, so now you have to make an 7:15 working, so now you have to make an 7:15 working, so now you have to make an adjustment. Okay, so now they can you 7:18 adjustment. Okay, so now they can you 7:18 adjustment. Okay, so now they can you know, you know, if a woman's 51 in 7:20 know, you know, if a woman's 51 in 7:20 know, you know, if a woman's 51 in menopause and now she's going to be 7:21 menopause and now she's going to be 7:21 menopause and now she's going to be using hormones for at least a decade if 7:23 using hormones for at least a decade if 7:23 using hormones for at least a decade if not longer, you want to make sure that 7:25 not longer, you want to make sure that 7:25 not longer, you want to make sure that that uterine lining over time is 7:27 that uterine lining over time is 7:27 that uterine lining over time is protected. 7:27 protected. 7:27 protected. >> Yeah, so doing a transvaginal ultrasound 7:29 >> Yeah, so doing a transvaginal ultrasound 7:29 >> Yeah, so doing a transvaginal ultrasound every once in a while, once a year is a 7:31 every once in a while, once a year is a 7:31 every once in a while, once a year is a great option to look at or if they're 7:32 great option to look at or if they're 7:32 great option to look at or if they're bleeding, then you do a transvaginal 7:34 bleeding, then you do a transvaginal 7:34 bleeding, then you do a transvaginal ultrasound right away to find out if 7:36 ultrasound right away to find out if 7:36 ultrasound right away to find out if it's thickening, fibroids, polyps, that 7:38 it's thickening, fibroids, polyps, that 7:38 it's thickening, fibroids, polyps, that kind of thing. I do feel like the um 7:42 kind of thing. I do feel like the um 7:42 kind of thing. I do feel like the um if you're 7:43 if you're 7:43 if you're if you really want to get those 7:44 if you really want to get those 7:44 if you really want to get those estradiol levels up cuz we love 7:46 estradiol levels up cuz we love 7:46 estradiol levels up cuz we love estradiol. I love to get the estradiol, 7:48 estradiol. I love to get the estradiol, 7:48 estradiol. I love to get the estradiol, you know, levels really good for, you 7:50 you know, levels really good for, you 7:50 you know, levels really good for, you know, for a woman to feel really great 7:52 know, for a woman to feel really great 7:52 know, for a woman to feel really great is you can consider rhythmic dosing. So, 7:54 is you can consider rhythmic dosing. So, 7:55 is you can consider rhythmic dosing. So, cuz when you're doing rhythmic dosing, 7:56 cuz when you're doing rhythmic dosing, 7:56 cuz when you're doing rhythmic dosing, you're going to use a progesterone 7:57 you're going to use a progesterone 7:57 you're going to use a progesterone cream. You can put it on transdermally. 7:59 cream. You can put it on transdermally. 7:59 cream. You can put it on transdermally. Some people we do it vaginally. A lot of 8:01 Some people we do it vaginally. A lot of 8:01 Some people we do it vaginally. A lot of times I do it more transdermally on the 8:03 times I do it more transdermally on the 8:03 times I do it more transdermally on the inner thigh. They do that progesterone 8:04 inner thigh. They do that progesterone 8:05 inner thigh. They do that progesterone from day 14 to day 28 and having a 8:07 from day 14 to day 28 and having a 8:07 from day 14 to day 28 and having a uterus, they would have a period. 8:09 uterus, they would have a period. 8:09 uterus, they would have a period. >> Yeah. 8:09 >> Yeah. 8:09 >> Yeah. >> So, that's where you're intentionally 8:11 >> So, that's where you're intentionally 8:11 >> So, that's where you're intentionally thickening up that uterine lining, but 8:12 thickening up that uterine lining, but 8:12 thickening up that uterine lining, but you're sloughing it off at the end, you 8:14 you're sloughing it off at the end, you 8:14 you're sloughing it off at the end, you know, at the end of your cycle like it 8:16 know, at the end of your cycle like it 8:16 know, at the end of your cycle like it was when we were getting our periods 8:17 was when we were getting our periods 8:17 was when we were getting our periods when we were younger. You know, our 8:18 when we were younger. You know, our 8:18 when we were younger. You know, our estrogen would increase up that lining, 8:20 estrogen would increase up that lining, 8:20 estrogen would increase up that lining, we'd ovulate, the corpus luteum would 8:22 we'd ovulate, the corpus luteum would 8:22 we'd ovulate, the corpus luteum would produce progesterone for 14 days if 8:24 produce progesterone for 14 days if 8:24 produce progesterone for 14 days if there wasn't fertilization, you get you 8:25 there wasn't fertilization, you get you 8:25 there wasn't fertilization, you get you get a period. So, you actually have 8:28 get a period. So, you actually have 8:28 get a period. So, you actually have these changing hormones that are 8:29 these changing hormones that are 8:29 these changing hormones that are mimicking exactly what you had when you 8:31 mimicking exactly what you had when you 8:31 mimicking exactly what you had when you were younger at that kind of proper 8:33 were younger at that kind of proper 8:33 were younger at that kind of proper manner. 8:33 manner. 8:33 manner. >> And with rhythmic dosing, you're 8:34 >> And with rhythmic dosing, you're 8:34 >> And with rhythmic dosing, you're purposely encouraging uh the period to 8:37 purposely encouraging uh the period to 8:38 purposely encouraging uh the period to to arrive every 25 days. So, in that 8:41 to arrive every 25 days. So, in that 8:41 to arrive every 25 days. So, in that context, that's the exception to the 8:43 context, that's the exception to the 8:43 context, that's the exception to the rule where progesterone cream is 8:45 rule where progesterone cream is 8:45 rule where progesterone cream is actually okay. Okay, but you cannot do 8:47 actually okay. Okay, but you cannot do 8:47 actually okay. Okay, but you cannot do that necessarily um you know, exactly if 8:49 that necessarily um you know, exactly if 8:50 that necessarily um you know, exactly if you're using some kind of a static 8:51 you're using some kind of a static 8:51 you're using some kind of a static dosing of some sort. Um bleeding is not 8:54 dosing of some sort. Um bleeding is not 8:54 dosing of some sort. Um bleeding is not an option when you're doing static 8:55 an option when you're doing static 8:55 an option when you're doing static dosing. Uh you know, um you know, so 8:58 dosing. Uh you know, um you know, so 8:58 dosing. Uh you know, um you know, so like I said, it really there's no way to 9:00 like I said, it really there's no way to 9:00 like I said, it really there's no way to predict that ahead of time. You cannot 9:02 predict that ahead of time. You cannot 9:02 predict that ahead of time. You cannot look at blood work, you can't look at 9:03 look at blood work, you can't look at 9:03 look at blood work, you can't look at anything that's going to tell you one 9:05 anything that's going to tell you one 9:05 anything that's going to tell you one way or the other. You have to implement 9:07 way or the other. You have to implement 9:07 way or the other. You have to implement some type of a treatment uh and and 9:09 some type of a treatment uh and and 9:09 some type of a treatment uh and and then, you know, see what happens over a 9:11 then, you know, see what happens over a 9:11 then, you know, see what happens over a period of time. 9:12 period of time. 9:12 period of time. >> Yeah, absolutely. So, I'd say some good 9:14 >> Yeah, absolutely. So, I'd say some good 9:14 >> Yeah, absolutely. So, I'd say some good alternatives would be vaginal 9:15 alternatives would be vaginal 9:15 alternatives would be vaginal progesterone um as a capsule, you know, 9:18 progesterone um as a capsule, you know, 9:18 progesterone um as a capsule, you know, or as a tablet. You could do vaginal 9:20 or as a tablet. You could do vaginal 9:20 or as a tablet. You could do vaginal cream, monitor that uterine lining. You 9:23 cream, monitor that uterine lining. You 9:23 cream, monitor that uterine lining. You could do vaginal um or you could do 9:24 could do vaginal um or you could do 9:24 could do vaginal um or you could do progesterone cream transdermally, 9:27 progesterone cream transdermally, 9:27 progesterone cream transdermally, monitor that uterine lining if you're on 9:28 monitor that uterine lining if you're on 9:28 monitor that uterine lining if you're on estradiol as part of your HRT. I've had 9:31 estradiol as part of your HRT. I've had 9:31 estradiol as part of your HRT. I've had some women that I'll do progesterone 9:33 some women that I'll do progesterone 9:33 some women that I'll do progesterone troches or sublingual or where put it on 9:35 troches or sublingual or where put it on 9:35 troches or sublingual or where put it on the inside of the cheek and it's 9:36 the inside of the cheek and it's 9:36 the inside of the cheek and it's supposed to absorb try you know sort of 9:38 supposed to absorb try you know sort of 9:38 supposed to absorb try you know sort of sublingually, but a lot of times it ends 9:40 sublingually, but a lot of times it ends 9:41 sublingually, but a lot of times it ends up melting and it can be a little bit of 9:42 up melting and it can be a little bit of 9:43 up melting and it can be a little bit of an oral ingestion and so women will say, 9:45 an oral ingestion and so women will say, 9:45 an oral ingestion and so women will say, I'm feeling groggy again or my anxiety 9:47 I'm feeling groggy again or my anxiety 9:47 I'm feeling groggy again or my anxiety is up or I'm getting bloated. So it is 9:49 is up or I'm getting bloated. So it is 9:49 is up or I'm getting bloated. So it is an option to try, but I do feel like 9:52 an option to try, but I do feel like 9:52 an option to try, but I do feel like women if you have progesterone 9:53 women if you have progesterone 9:54 women if you have progesterone sensitivity to oral HRT progesterone is 9:57 sensitivity to oral HRT progesterone is 9:57 sensitivity to oral HRT progesterone is you don't have to take it. There are 9:59 you don't have to take it. There are 9:59 you don't have to take it. There are other alternatives just work with your 10:00 other alternatives just work with your 10:00 other alternatives just work with your practitioner to find the right thing for 10:02 practitioner to find the right thing for 10:02 practitioner to find the right thing for you. 10:02 you. 10:02 you. >> No, I just speaking with someone just 10:04 >> No, I just speaking with someone just 10:04 >> No, I just speaking with someone just the other day and they started noticing 10:07 the other day and they started noticing 10:07 the other day and they started noticing a little bit of a weight gain with oral 10:09 a little bit of a weight gain with oral 10:09 a little bit of a weight gain with oral progesterone. So they started taking the 10:11 progesterone. So they started taking the 10:11 progesterone. So they started taking the oral progesterone with with estrogen 10:14 oral progesterone with with estrogen 10:14 oral progesterone with with estrogen taking it every other day. Is that is 10:16 taking it every other day. Is that is 10:16 taking it every other day. Is that is that a possibility? 10:18 that a possibility? 10:18 that a possibility? >> You know, I don't think so if you're 10:19 >> You know, I don't think so if you're 10:19 >> You know, I don't think so if you're doing static dosing. I don't I wouldn't 10:21 doing static dosing. I don't I wouldn't 10:21 doing static dosing. I don't I wouldn't recommend it that way. 10:22 recommend it that way. 10:22 recommend it that way. >> Mhm. 10:23 >> Mhm. 10:23 >> Mhm. >> Because in some respects 10:25 >> Because in some respects 10:25 >> Because in some respects I'm going to feel gro gro I'm going to 10:26 I'm going to feel gro gro I'm going to 10:26 I'm going to feel gro gro I'm going to take my progesterone tonight. I'm going 10:27 take my progesterone tonight. I'm going 10:27 take my progesterone tonight. I'm going to feel groggy tomorrow. That's a real 10:28 to feel groggy tomorrow. That's a real 10:28 to feel groggy tomorrow. That's a real bummer. The next day I'm not. I mean, 10:30 bummer. The next day I'm not. I mean, 10:30 bummer. The next day I'm not. I mean, you don't want to live your life where 10:31 you don't want to live your life where 10:31 you don't want to live your life where you're groggy or you're not feeling well 10:33 you're groggy or you're not feeling well 10:33 you're groggy or you're not feeling well 50% of the time. It's really let's find 10:35 50% of the time. It's really let's find 10:35 50% of the time. It's really let's find another alternative that's going to work 10:36 another alternative that's going to work 10:36 another alternative that's going to work for you. 10:37 for you. 10:37 for you. >> Well, my point was if she's taking it 10:39 >> Well, my point was if she's taking it 10:39 >> Well, my point was if she's taking it every other day, is that enough uterine 10:41 every other day, is that enough uterine 10:41 every other day, is that enough uterine protection if she's taking some form of 10:43 protection if she's taking some form of 10:43 protection if she's taking some form of estrogen? 10:44 estrogen? 10:44 estrogen? >> You know, everybody's different. It 10:45 >> You know, everybody's different. It 10:45 >> You know, everybody's different. It might be it might be or it could be a 10:47 might be it might be or it could be a 10:47 might be it might be or it could be a lot of times I'll have women cuz their 10:49 lot of times I'll have women cuz their 10:49 lot of times I'll have women cuz their uterus is the in the inside of their 10:51 uterus is the in the inside of their 10:51 uterus is the in the inside of their uterine lining are so sensitive to the 10:53 uterine lining are so sensitive to the 10:53 uterine lining are so sensitive to the estradiol or just hormone change 10:56 estradiol or just hormone change 10:56 estradiol or just hormone change whatsoever that if they took the 10:58 whatsoever that if they took the 10:58 whatsoever that if they took the progesterone or they even miss one of 10:59 progesterone or they even miss one of 10:59 progesterone or they even miss one of their doses, they get a little spotting 11:01 their doses, they get a little spotting 11:01 their doses, they get a little spotting or they don't feel well. So 11:03 or they don't feel well. So 11:03 or they don't feel well. So I you know, it's one of those things 11:05 I you know, it's one of those things 11:05 I you know, it's one of those things where there are so many alternatives to 11:07 where there are so many alternatives to 11:07 where there are so many alternatives to fit for the right person that instead of 11:09 fit for the right person that instead of 11:09 fit for the right person that instead of just piecemealing it or dealing with it 11:11 just piecemealing it or dealing with it 11:11 just piecemealing it or dealing with it is just finding the right way to tailor 11:12 is just finding the right way to tailor 11:13 is just finding the right way to tailor it to you. 11:13 it to you. 11:13 it to you. >> Absolutely. 11:14 >> Absolutely. 11:14 >> Absolutely. And that's where if there is any 11:15 And that's where if there is any 11:15 And that's where if there is any bleeding that's sort of hard to control 11:19 bleeding that's sort of hard to control 11:19 bleeding that's sort of hard to control and you don't tolerate the progesterone 11:21 and you don't tolerate the progesterone 11:21 and you don't tolerate the progesterone then you know, there are some other 11:22 then you know, there are some other 11:22 then you know, there are some other alternatives out there that you know, 11:24 alternatives out there that you know, 11:24 alternatives out there that you know, that make it 11:25 that make it 11:25 that make it you know, cuz we don't want anybody to 11:26 you know, cuz we don't want anybody to 11:26 you know, cuz we don't want anybody to feel you know, sort of like they're 11:28 feel you know, sort of like they're 11:28 feel you know, sort of like they're drugged or they're tired or anything 11:30 drugged or they're tired or anything 11:30 drugged or they're tired or anything like that or they're bloated all the 11:31 like that or they're bloated all the 11:31 like that or they're bloated all the time or anxious. Yeah, those are You 11:33 time or anxious. Yeah, those are You 11:33 time or anxious. Yeah, those are You don't have to just um deal with it 11:36 don't have to just um deal with it 11:36 don't have to just um deal with it cuz there are you know, there are some 11:37 cuz there are you know, there are some 11:37 cuz there are you know, there are some other still very effective but also very 11:39 other still very effective but also very 11:40 other still very effective but also very safe options for a woman when she's you 11:42 safe options for a woman when she's you 11:42 safe options for a woman when she's you know, when she's using both estrogen and 11:44 know, when she's using both estrogen and 11:44 know, when she's using both estrogen and progesterone. 11:45 progesterone. 11:45 progesterone. Okay. Uh anything else? 11:46 Okay. Uh anything else? 11:46 Okay. Uh anything else? >> This was great. We'll probably come back 11:47 >> This was great. We'll probably come back 11:47 >> This was great. We'll probably come back around and do one more about bleeding so 11:49 around and do one more about bleeding so 11:49 around and do one more about bleeding so we can really deep dive into that. 11:51 we can really deep dive into that. 11:51 we can really deep dive into that. >> Yeah, yeah. We'd love to hear your 11:52 >> Yeah, yeah. We'd love to hear your 11:52 >> Yeah, yeah. We'd love to hear your comments down below with your experience 11:54 comments down below with your experience 11:54 comments down below with your experience with uh oral progesterone. Some love it, 11:56 with uh oral progesterone. Some love it, 11:56 with uh oral progesterone. Some love it, some hate it. Uh some are in between. Um 11:59 some hate it. Uh some are in between. Um 11:59 some hate it. Uh some are in between. Um so until next time, I'm Dr. Maki. 12:01 so until next time, I'm Dr. Maki. 12:01 so until next time, I'm Dr. Maki. >> And I'm Dr. Valerie. 12:02 >> And I'm Dr. Valerie. 12:02 >> And I'm Dr. Valerie. >> Take care. Bye-bye.
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